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8022.1 <br />Appendix 12c <br />RESTRICTIOIiS ON LOBBrIHG - CERTIrIC~-TION <br />By eubom,ittinq this application, the applicant certiiiss, to <br />the best of his or her knwledge and belief, thst~ <br />(1) Ho Federal appropriated funds hnve been paid or rill ba <br />paid, by or on behalf of the undersigned, to any person for <br />influencing or attempting to influence an officer or <br />employee of any agency, a ~sember of Congress, an officer or <br />employee of Congress, or an employee of a Member of Congress <br />in connection rith the awarding of any federal contract, the <br />sin,kiaq of any Federal grant, Lhe mkt.ng of any Federal lom, <br />the entering into of any cooperative agreement, and the <br />extension, continuation, renewal, amendment, or saadification <br />of any Federal contract, grant, cooperative agreement, or <br />loan. <br />(Z) If any funds other than federal appropristed funds have <br />been paid or rill be paid to any person for iafluencinq or <br />attempting to influence an officer or employee of any <br />agency, a l~iember of Congress, en officer or employee of <br />Congress, or 'an employee of a Kember of Conq~ress in <br />connection with this Federal contract, grmt, cooperative <br />agreement, or loan, the undersigned shall camplste and <br />submit Standard Form-LLL, 'Disclosure Form to Report <br />Lobbying," in accordance rich its instructions. ti <br />(3) The undersigned shall require thst the langvege o! thi• <br />certification be included in the award docuaents for ell <br />subavards at all tiers (including subcontracts, subgrents, <br />and contracts ender grants, loans, sad cooperative <br />agreements) and that ali subrecipients shall certify and <br />disclose accordingly. <br />This certification is a suxterial representation of fact upon <br />rrbich reliance vas placed rhen this transaction ras mde or <br />•ntared into. Submission of this certification is a <br />prerequisite for asking or antarinq into Ibis tsaruaction <br />imposed by section 135, title 31, D.S.C. Any person rbo <br />fails.. tea file the required certification shell be subject to <br />a civil penalty of not lass than 510,000 and not sore than <br />5100,000 for each each failure. <br />6/90 12c-6 <br />